1. TB notification

2. Background - I
TB is a major health public health problem accounting for substantial morbidity and mortality in the country.
I n order to ensure TB diagnosis and case management, reduce TB transmission and address the problems of emergence and spread of drugs resistance TB.
It is essential to have complete information of all TB cases. Therefore, the health care providers shall notify every TB cases to local authority.

3. Background - II
Large nos. of TB pts availing services from private sectors are not reported to the program me.
A large nos. of pts are not benefitted with program me services which leads to non adherence, incomplete, inadequate treatment leading to M/XDR TB.
If TB pts diagnosed and treated in Pvt. Sectors are reported to public Health authority, the mechanism available in this system can be extended to these pts ensuring treatment adherence and completion.
To prevent the impending epidemic of M/XDR TB and to curve the situation Govt. of India declared Tuberculosis a notifiable disease on 7th May 2012.

4. Objectives
To have establish Tuberculosis surveillance system in the country.
To extend mechanisms of TB treatment adherence and contact tracing to pts treated at Pvt. Sector.
To ensure proper TB diagnosis and case management and further accelerate reduction of TB transmission.
To mitigate the impeding drug resistant TB epidemic in the country

5. Minimum information requirement for TB notification
TB pts name
Age/gender
GoI-issued personal unique identification nos.
Detailed address of TB case with pin code.
Phone Number
Basis of diagnosis: Microbiologically confirmed TB case/Clinical TB case.
Patient category: New/Recurrent TB case/ treatment Change.
Site of disease: pulmonary/EP only.
Rifampicin resistance: Resistance/Sensitive/not available (& other drug resistance pattern by laboratories)

6. Definition of TB cases for purpose of Notification
Microbiologically confirmed TB Cases: pts diagnosed with at least one sputum positive or a culture positive or RNTCP approved rapid diagnostic molecular test for MTB.
Clinical TB case: pts clinically diagnosed TB without Microbiologic confirmation & initiated on anti-TB drugs.

7. RNTCP endorsed TB diagnostics
Smear Microscopy (for AFB).
FM with Fluorescence stains.
SOLID CULTURE:
Solid media (L J media)
Liquid media ( Middle Brook) using manual, semiautomatic or automatic machines e.g. Bactec, MGIT etc.
RAPID MOLECULAR TEST: Conventional PCR based Line Probe Assay for MTB complex or Real Time PCR based NNAT e.g. GeneXpert.

8. Health care providers for TB notification
clinical establishments run or managed by the Government (including local authorities)
private or NGO sectors and/or individual practitioners.
The healthcare providers shall notify every TB case to local authorities i.e. District Health officer/CMO of a district/ Municipal Corporation/Municipality in every month in given format.

9. Registration of Health establishments for TB notification
Health establishment is divided into three categories :
1.Laboratories
2.Private practitioner/Clinic (single)
3.Hospital/Clinic /Nursing Home (multi)
Each of the Health Establishment will be registered for TB notification by submitting a simple registration form mentioning the details of the establishment. The registration form can be availed from the nodal officers for TB notification can be down loaded from tbcindia.nic.in.
Each health establishment will receive the unique number.

10. Mechanism of TB notification
Route for information transmission:
Submission by:
Hard copy to the nodal officer for TB notification. a) by post b) by courier c) by hand.
Soft copy by authorized .
By authorized mobile: phone call/IVRS/SMS *
Uploading of information directly to Nikshay portal under construction. In future direct online TB information transmission from CBNAAT or MGIT etc may include.

11. TB Notification using Nikshay

12. TB Notification using mobile app

13. HEALTH FACILITY REGISTRATION
SL No
District
Type
Registered
Hospital/Clinic/Nursing Home
Laboratory 1
CCP
Nil
(1) 2
Imphal East
(3) 3
Imphal West 5 4
(9)
Tamenglong
Thoubal
(2) 6
Ukhrul 7
Chandel 8
Senapati 9
Bishnupur
State 12 19

14. No. of Notified Patients 2Q14 No. of Notified Patients
State
District
TBUnit
HFIDNO
Health Facility
Address
Pinno
Type
No. of Notified Patients
Manipur
CCP
DTC
67113
MSF
795158
Clinic 86
Imphal West
DTC-TU
75211
IMPHAL HOSPITAL
795001 14
75214
Shija Hospital
Hospital 4
75208
ADARSH
Lab 17
75054
Omega
Uripok 3
TML
75145
795141 20
Thoubal
Kak_TU
75204
Jivan Hospital
KAKCHING
795103
Ukhrul
2247
Leishiphu Christ. Hospital
UKL
795142 29
Total notified patients as on 25th August 2014
177

15. IMPHAL EAST THOUBAL UKHRUL
Health Facility Who Have Not Initiated Patient Data Entry Report
SL No
Name
Type
Sector
IMPHAL EAST
JNIMS
Hospital/Clinic/Nursing Home
Public
Babina Diagnostics
Laboratory
Private
Public Hospital and Research Institute
THOUBAL
SUPRIYA DIAGNOSTIC CENTRE THOUBAL
UKHRUL
Comprehensive Health Services and Research Centre

16. Health Facility Who Have Not Initiated Patient Data Entry Report
SL No
Name
Type
Sector
IMPHAL WEST
Mona Laboratory X-ray
Laboratory
Private
Sky Hospital
Hospital/Clinic/Nursing Home
Padma Diagnostic Centre
Raj Medicity
Districts which do not have private health facilities
Senapati
Tamenglong
Bishnupur
Chandel

17. TB notification status

18. TB notification status

19. Responsibility of the district level nodal officer/Local public health authority
Disseminate information
Provide formats
Ensure registration of all HE by Dec 2012 and given the unique ID
Maintain a list of HE with details & IDs
Capacity building of MOs and health staff
Ensure all notified cases are entered in the NIKSHAY portal within two weeks from submission of reports
Routinely review the progress

20. Responsibility of the health worker -I
Regular visit all HE & promote understanding and requirement about TB notification
Provide formats of TB notification & registration forms to all HE
Collect, collate and upward submit the TB notification reports submitted by the HEs
Ensure that all TB cases notified by the HEs are entered in NIKSHAY portal

21. Responsibility of the health worker -II
Visit the TB patients notified by HEs in consultation with them for timely & public health action:
a) COUNCELING of TB pts for treatment adherence & Follow up to ensure treatment completion
b) TB contract tracing ,screening for symptoms referral for evaluation for TB
c) Offering INH chemoprophylaxis
d) Family members counseling
e) Offering TB treatment under RNTCP if desired by the pts
d) Advising on ICTC services, further testing of C&DST, if desirable

22. Challenges
Sensitization of huge no. of private health care providers with inadequate HR is a big challenge.
Following up notified cases as a public health responsibility in manner acceptable to pts and community.
Managing huge information at different level and creating a national TB register.